Dermacare of San Diego

Who would have predicted it, a Botox date?  In the last month I have had several couples come into the office to get Botox together. There was a little more laughter that the usual Botox appointment.  Combine it with lunch and no kids.  Maybe these couples are on to something?

Transitions are a good time for reflection on the past,
celebrations of accomplishments coupled with lessons to be learned.  Transitions are also a time for looking
ahead, dreaming dreams and taking stock of the work that needs to be done to
accomplish those dreams.  A new year is
one of the transition times.  So here
goes…

We at Dermacare have a lot celebrate.  Economic turmoil has not been kind to many of
us, however, we feel fortunate to have seen significant growth in our business
last year.  Our esthetician staff has
given nearly 500 chemicals peels and completed over 1800
microdermabrasions.  Our nurses have
performed over 5000 laser hair treatments, 1500 skin rejuvenation laser
treatments and 500 Fraxel laser treatments.
We injected over 55,000 units of Botox and over a 1000 syringes of
Juvederm and Radiesse, and as many of you know we became “Black Diamond”
providers for Allergan, which puts us in the top 1% in the country.  This growth has put an increased demand on
our time and resources.  We have strived
to continue to give the same personalized and careful treatments to everyone
and have appreciated your patience has we have gone through some growing pains.

We have also had changes in some of our staff this
year.  We celebrate with Megan, as she
left us to become a new mother to her healthy baby son, Dylan, and miss Kelly
as she moved to Texas to be with her new husband.  Coupled with losing some key staff, we
welcome new members to our family.
Lanie, Sara (who you will meet later in the newsletter) and Jenna are
our new estheticians and Susan has joined our experienced team of nurses.

As part of our commitment to providing the best technologies
for medical skin and beauty needs, we are expanding our body sculpting services
to include BodyJet, water-assisted liposuction and NaturalFill fat
transfer.  The key advantage of the
BodyJet liposuction is that it preserves the health of the harvested fat cells
and associated stem cells.  NaturalFill
is the process of taking those cells and re-injecting them back into selected
spots in the body.  We can do this for
face and hand rejuvenation, as well as breast and butt augmentation.  NaturalFill is done while awake, without
general anesthetic and with minimal down time.

I personally want to thank my excellent staff for all their
contributions over the last year and I speak for everyone at Dermacare in
thanking you, our clients, for the trust and confidence that you put in us each
time you visit.   We are all looking
forward to serving you this year.

When it comes to maintaining good looking skin the most important thing you can do (assuming you don’t smoke) is to avoid sun exposure to the skin.  We live in San Diego because we like an active lifestyle, which includes being outside enjoying our beautiful weather, so for most of us, avoiding the sun means sunscreens.  Recently, the FDA released new regulations, which will make it easier for you to choose a good sunscreen.  Because these regulations will not take affect until 2012, you need to understand the guidelines so you can make good choices this summer.

The sun has 2 major negative affects on our skin.  First, the ultraviolet light in the sun can cause cancer.  Basal Cell and Sqamous Cell Carcinomas are rarely deadly but treatments can be disfiguring.  Melanoma is scary.  The second concern is that the sun ages the skin by increasing the brown spots and by breaking down collagen, which leads to fine lines, wrinkles and larger pores.

The first steps in protecting the skin are avoidance.  The most intense time of the day for sunrays is between the hours of 10am and 3pm.  Move your exercise time to early or late in the day. Protective clothing is another good way to shield you skin.  Add a variety of hats to your “style” portfolio. Finally, take advantage of shade, whether this is under a tree or umbrella.  Your skin will thank you.

Now on to sunscreens:  The biggest change to the new labeling regulations is the use of the term “Broad Spectrum”.  This means that the sunscreen must meet FDA standards at protecting against both UVA and UVB. This is important as the traditional “SPF” rating refers to UVB protection only.  This is the sunlight that causes sunburns.  The problem is that it is the UVA that causes cancer.  Now, with the “Broad Spectrum” designation you will know that you are protected for both.  In the mean time, look for sunscreens that contain Avobenzone or zinc and titanium oxides.

The next change in regulations is the addition of a warning label if the SPF is less than 15.  These products do not provide adequate protection to prevent skin cancers.  Additionally, the highest SPF rating will be 50+.  Anything higher than 50 has not been shown to add extra benefit.  So, don’t spend extra money on products with a SPF rating higher than 50.

The third change will be the elimination of the terms “waterproof” and “sweatproof”.  The manufactures will be able to use the term “water resistant” if they can show effectiveness is maintained in these wet conditions.  Even with water resistant, always reapply frequently if participating in water activities or exercising.

Finally, the FDA will be stricter on labeling regarding how often to reapply.  Most sunscreens only remain affective for 2-3 hours in ideal conditions and need to be reapplied.  To be able to label as longer acting the manufacturer must demonstrate adequate protection for the longer time.  Generally speaking, only zinc and titanium oxide greater than 6% will give protection longer than 2-3 hours.  This point is really important to understand as many women use moisturizers in the morning that contain sunscreen. These are only affective for the 2-3 hours mentioned above.  You need to reapply again to remain protected from the mid day sun.

The FDA has done a nice job in forming the new regulations.  It will make it easy to pick up out good sunscreens, i.e. Broad Spectrum with SPF15 or higher, +/- water resistance.  After these guidelines are met you now need to find one that is also right for your skin.  Do you have, dry skin, oily skin, sensitive skin?  Dermacare has the right sunscreen for each of these skin types.  We also carry “Sunforgettable”; a zinc/titanium based, powder sunscreen, that is easy to apply over your makeup through out the day.  Make sure you talk to one our staff to see which will be best for you.

For keeping your skin looking young and beautiful, don’t neglect the importance of sunscreen.  In my practice all the ladies with great skin in their 60’s have 2 things in common.  They started using retinols and sunscreen early, and have used them consistently through the years.  Now it is your turn!

When I tell people what my husband does…I’m not going to lie…I get the comment, “How did you get so lucky?”  Well, I am lucky, not only is my husband a really nice guy, he’s really good at his job! The other reason that I’m lucky is that I get asked if my daughters and I are sisters!  I love that! We’re all lucky because there are so many options out there to help us keep ourselves looking on the outside as young as we still feel on the inside.

I was sitting here thinking about what procedures I should tell you about and having a difficult time deciding.  I guess I’ll just tell you about my favorite ones…mmmm…still too many…I guess I’ll just pick two now and I can tell you about more later!  My first question to people is always, “what bothers you the most?”  For me, it was how pink my skin always was.  No matter what I did to it, it was always really pink. Not just a healthy pink, but an annoying pink!

Well, lucky me because “we have a laser for that!”  (Apparently this is my tag line.)  Well, the way to get rid of pink is the Genesis Laser.  This is a very simple procedure that takes only about 20 minutes and you can go right back to work or have lunch or whatever.  This laser never touches your skin, but sends down a warm tingling feeling. It’s kind of like a warm, gentle drizzle on your face.  The results are awesome.  Not only does this get rid of the pink, but it helps to rejuvenate the collagen and decreases fine lines, wrinkles and it helps decrease your pore size. The Genesis is also a great maintenance treatment to do every few months.  The other thing I like about this laser is that you can do a genesis on your face, neck, chest and I’ve even done it on the back of my arms for a little tightening effect!  I like to think of the Genesis as an unsung hero!

Dr. Birchall’s Wife (a.k.a. Sarah)

Technology provides help for one of the most challenging issues of aging. One of the most frustrating, age-related skin care issues is what is known as “crepiness”; dry, loose, papery skin that has an almost shriveled appearance. Often irregular in texture and color, it most frequently appears on our necks, under the eyes, on the hands, chest or even on arms and legs. Unfortunately, crepiness is one of the most tell-tale signs of age.

Why does crepiness appear?

Youthful skin is full of elastin and collagen giving the skin that tight, full, dewy look. The underlying problem with crepe skin is the loss of these structural proteins. For the first 30 years of our lives we produce more of these proteins than we lose. After that we experience a net loss of these proteins. There are also other factors that influence this as well. Genetics is one of several significant factors. Those of you with dark, thick or oily skin should be grateful for the positive effect it has on your skin’s proteins! In addition environmental factors such as smoking and sun exposure play a role. Obviously, the emphasis is on minimizing the environmental factors we can control to slow the loss of skin’s structural proteins.

What are the solutions?

Women in our clinics who have great skin in their sixties have two things

Fraxel Cheeks: Before and After

in common.  They have used sunscreen and retinol on a daily basis for their adult lives.  Day to day you may not see the difference but over the years that is an undeniable benefit to these habits.  The second thing is they don’t smoke.  Additionally, antioxidant creams, vitamin C and glycolic acid have proven beneficial.

Sometimes despite all things mentioned, you may need more help with crepe skin.  The big gun is Fraxel.  This laser penetrates the full depth of the skin, stimulating the production of elastin and collagen making the skin thicker and fuller.  Additionally, it reduces the brown spotty appearance of crepe skin. Those in their 60 somethings mentioned earlier with great skin, continue to do Fraxels as well. They understand the importance to maintaining the structural proteins, elastin and collagen in their skin.  They are fighting to keep their skin looking healthy and vibrant as long as possible.  Now, Fraxel is not for everyone.  Other lasers, such as Genies, IPL, PhotoDynamic Therapy also have their place in fighting crepiness. 

Ultimately, we will need to evaluate your skin and make a recommendation that will be right for you.

We have been reviewing our LifeSculpt procedures (laser assisted liposuction) and have found that we are averaging 15 LifeSculpts per month, since we introduced LifeSculpt in January of last year.  Patients are noticing chin lines are improving, arms are looking more toned, pant sizes are about 2 sizes less and their “muffin tops” are gone. All of these results from an office procedure that reduces the risk and cost of traditional liposuction while improving the results.   Our before and after portfolio is growing as we capture your “shrinking” success stories, so make sure to ask to see these at your next visit.

LifeSculpt at Dermacare- Chin Before

LifeSculpt at Dermacare- Chin After

For me and my family this is the Christmas Season.  A chance to reflect on those people in our lives that have allowed us to get through another year.  A chance to show the people around us that we care about them and appreciate them.  A time to be grateful for the many blessings, material and otherwise, we enjoy, all because of God’s grace lavished in many ways.  Our wish is for your joys to be multiplied this year.

Merry Christmas!

The Fraxel laser revolutionized the laser skin care industry when it was introduced in 2003.  Prior to that the CO2 and erbium lasers were the key lasers for skin rejuvenation and collagen stimulation.  Unfortunately, these lasers had significant complications rates, long down times (4-5wks) and were not safe on darker skin types.  By “fractionating” the treatment pattern into a pixilated pattern, only a fraction of the skin (~15-25%) was treated.  The surrounding untreated skin, would allow faster healing.  By doing this “fractionated” pattern, the complication rate was much less and the down time was reduced to 24hrs.  The success of this strategy prompted several other laser manufacturers to mimic this approach, so now there are at least 20 different fractionated lasers.

While other competitors were trying to keep up with Fraxel, the Fraxel laser was also evolving.  Their first improvement was to increase the power of the original Fraxel.  This Fraxel II would penetrate deeper in the skin allowing more complete collagen stimulation and deep pigment reduction.  Fraxel II is the most commonly available Fraxel laser and the one we use here at Dermacare.  Later it was renamed the Fraxel “Restore” laser.  The Fraxel company then developed the Fraxel “Refine” laser, a lower powered laser and designed mostly for superficial brown pigment.  Their next big modification was to apply the fractionated technology to a CO2 laser and this is the Fraxel “Repair” laser.  With one treatment you get the same collagen stimulation and skin tightening but with downside of more wound care, more down time, and higher complication rate. Finally, they have release a laser called the Fraxel Duo, that is a further modification of the Fraxel II.

When opening our second clinic, in Carlsbad, I gave strong consideration to getting the CO2 Repair laser rather than the Restore.  We finally settled on another Fraxel Restore for the second office.  Our research showed that for most people the extra downtime and complication rate are not worth it.  I agree, the Fraxel Restore (a.k.a Fraxel II) seems to be the best balance between effectiveness and complications/down time.  When you are doing your research and reading other people’s experiences, be sure you understand which Fraxel (Restore or Repair) they are commenting on.  Further, recognize that patient rating sites have a much lower satisfaction rate then our experience.  We find that over 90% of our clients have good to excellent results, which is consistent with independent survey’s of patient satisfaction.

Fraxel Before

Fraxel After

Is there any thing worse than too much Juvederm in the lips?  Of all the areas we can use Juvederm and other fillers, none causes as much concern as the lips.  We have all seen too many “Real Housewives” and Hollywood types who have bad lip jobs.  Recently, I have had a parade of these bad lip injections done by other providers come through our office.  I want to scream.  “They don’t have to look that way!!”  The problem is that people put too much material in the lips.  In all these cases, at least 2 full syringes were used.  When done well you can’t tell there was Juvederm put in lips, it just look better. 

So, what does it take to be done well?  First, the provider has to have the right perspective.  Especially in mature lips (40+) the goal is to restore the lips to their previous volume.  As we age, our lips loose volume and shrivel; hence the goal is to restore that volume.  Second, the client needs to have the right perspective.  One of the main goals in lip injections is to eliminate the vertical lip lines or smoker’s lines.  Unfortunately, what can happen is that when you put enough product in to eliminate those lines you distort the look.  We should expect to reduce the lines, not eliminate them completely. To help with this, make your decisions 5-7 feet from the mirror not 12 inches from the mirror.  Finally, don’t use too much product!  As general rule, 1 syringe works well for the lips. Occasionally, we use more but that is for select clients with the right face, lips and personality to make it work.  Remember, when you see someone who had their lips done you are seeing a bad lip injection,  “They don’t have to look that way!”

At Dermacare, sometimes clients struggle with what it means to “age gracefully”.  They ask themselves: should I get a Fraxel, Botox, or just accept the changes in my face and “age gracefully”?   These questions have made me wonder what does it mean to age gracefully?  Maybe getting treatments is aging gracefully.   Aging gracefully will mean different things to different people.  I am thinking it’s a more a state of mind, and youthful attitude rather than how we look.  With life’s experiences, we develop a calmness, security and acceptance of who we are as a person.  My grandfather always told me to keep learning, as he knew it was important to staying vibrant.  I have also seen how involvement in others wellbeing keeps people vibrant throughout their lives.  Maybe Botox has nothing to do with aging gracefully other than it reflexes a healthy sense of self-respect and recognition that I am still a vibrant person worth caring about.